Can large relative mortality differences between socio-economic groups among Swedish men be explained by risk indicator-associated social mobility?

Background: The Nordic countries, profiled as welfare states, are shown to have comparatively large relative socio- economic differences in mortality and comparatively high intergenerational mobility. The aim of this study was to analyse the role of risk indicator- associated social mobility ( from childhood through to adulthood) in socio- economic mortality differences among Swedish men aged 35 - 50 years. Methods: We used data on risk indicators for adult mortality ( risk use of alcohol, smoking, low emotional control, psychiatric diagnosis, medication for nervous problems, contact with police and child care, experience of unemployment, low body height, low education) collected at compulsory conscription for military training among Swedish men at aged 18 - 20, fathers' socio- economic status at subjects' ages 9 - 11 years, data on subjects' socio- economic status at ages 34 - 36 years, and follow- up data on mortality during 1986 - 1999 ( at ages 35 - 50 years). Results: Persons in manual occupations in 1985 showed an elevated relative risk ( RR) of mortality compared with stable non- manual employees regardless of the social position of their father ( RR 1.75 among stable manual workers, and RR 1.74 among the downwardly mobile). In multivariate analyses, taking into account the risk indicators first operating in late adolescence, the increased mortality risk among stable manual workers and also among the downwardly mobile diminished considerably ( RR 1.32 and 1.39, respectively). Conclusions: These results suggest that a substantial part of the socio- economic differences in mortality among middle- aged men had their origin in childhood circumstances. Risk indicator- associated social mobility was found to contribute substantially to an increase in the relative difference in mortality between male manual workers and nonmanual employees.